Persuasions #12, 1990                                                                                                                                            Pages 117-130


What is Wrong with Marianne?  Medicine and

Disease in Jane Austen’s England



Associate Professor of English, Goucher College



University of Maryland Cancer Center


Jane Austen’s novels and letters are full of discussions about the diagnosis and treatment of accidents, fevers, nervous “headackes,” gout, hysterias, and rheumatisms – all of the common ailments that made life miserable during the late eighteenth and early nineteenth centuries.1   In fact, in every one of her novels Jane Austen depicted illness and invalids.  Mr. Woodhouse, of course, has his own peculiar brand of dyspepsia, and he has Mr. Perry, his attentive apothecary; Jane Bennet suffers from a bad cold, which is seen to by Mr. Jones; Mrs. Bennet’s “nerves” have irritated her husband for a span of about two decades; Lady Bertram falls victim to ennui and self-indulgence; Fanny Price may simply be anemic.  But two novels in particular – Sense and Sensibility and Persuasion –demonstrate Jane Austen’s familiarity with the illnesses that were prevalent during her lifetime.  Sense and Sensibility, which we will concentrate on in this paper, uses a multitude of common medical emergencies as plot elements that propel action, and Persuasion, which Jane Austen began writing when she herself was already ill, has more accidents and ailments than any of her other novels.

Jane Austen was obviously well informed about illnesses and common remedies, and she would have been a terrific physician.  Her acute observation of life and society parallels quite closely the few medical treatises of the time that one finds readable and/or comprehensible now.  Jane Austen examined the foibles of people as carefully as the best medical men scrutinized their physical findings.  It certainly seems that her comments about illness and diagnosis are a reflection of how much – or how little – doctors actually knew.  In addition, she kept up with the newest medical ideas.  On Thursday, 20 November 1800 she wrote to Cassandra that “We had a very pleasant day on monday [sic] at Ashe,” where “James & Mrs. Augusta alternately read Dr. Jenner’s pamphlet on the cow pox.”2  Jenner is important here, because it seems that the writer had a more sensitive appreciation of his work on vaccine inoculation than did some of the renowned medical men of her time.  Benjamin Mosely, for example, had written a treatise on Tropical Diseases and had held many high medical posts, yet he unenlightenedly supported “the popular prejudice that the cow-pox would turn men into cattle, [and went so far] as to state in a professional controversial treatise that he had himself seen oxfaces growing on human beings after vaccination … and [he] described the phenomena in some detail.”3


It is singular, that notwithstanding the unanimity which obtains, in the respectable part of the profession, on the decided advantage of practising vaccine inoculation, that it is still obstinately resisted by a very numerous class of people …: false accounts of its failures, with untrue and disgusting details of its producing loathsome and unknown disorders, still continue to be propagated by interested individuals, and impede the adoption of a remedy, which would, yearly, save thousands of people to the state.

(Ackermann’s, June, 1809)


One physician-writer in particular, Dr. William Heberden, who was born in London in 1710 and died quite famous in 1801, had a writing style remarkably like Jane Austen’s, something rather uncharacteristic of other physicians at that time.  Dr. Heberden, in his Commentaries on the History and Cure of Diseases (1798),4 comments as follows on the Bath spa:


Many judicious and experienced physicians have a favourable opinion in the internal use of Bath water in Flying pains and weaknesses of the limbs, in rheumatisms, and in the simple jaundice, where the liver is not diseased.  From the cases of this sort which have fallen under my observation, I should rather conclude it to be innocent in them, than of any great use.


While Jane Austen satirizes the fashionable insipidity of Bath life in her novels, Dr. Heberden provides scientific evidence for her assessments.  He comments on the increase of gouty “complaints” at Bath, which he attributes to the “vacancy of a Bath life,” for he notes that there is little at Bath to offer constructive “employment” and “application.”  Using a wonderfully ironic tone, much like Jane Austen’s tone in her novels and letters, Heberden observes that “the dread of being cured of the gout was, and is still, much greater than the dread of having it.”  He comments further that:


Strong wines, and in no small quantity, have the reputation of being highly beneficial to gouty persons; which notion they have very readily and generally received, not so much perhaps from a reasonable persuasion of its truth, as from a desire that it should be true, because they love wine.


An ample provision has been kindly made, sometimes by duplicates, of several parts of the body which are indispensably useful to life, that in case one of them, or some part should fail, there may still be enough remaining to answer their purpose in a tolerable manner.  The lungs afford an example of this ….


Arthritic patients, who were as incapable of moving themselves as their malady could make them, upon the sudden alarm of fire, or other dangers, have, by an instantaneous exertion, recovered, and made very good use of their limbs.


In England we have very little apprehension of the contagious nature of consumptions; of which in other countries they are fully persuaded.  I have not seen proof enough to say that the breath of a consumptive person is infectious; and yet I have seen too much appearance of it, to be sure that it is not ….


Sense and Sensibility, Jane Austen’s first published work, is a disturbing book to have been written by such a young writer.  What makes this book so bleak is the fact that it is a novel about illness and suffering.  It is a book in which Marianne, a most delightful and charming heroine, is essentially paralyzed by her grief over her lost lover, while her sister Elinor hides her own sadness over disappointed love by burying herself in action and good works – Dr. Heberden would have called her activity “application” and “employment.”  In this novel of antitheses, the usual polarities abound:  Elinor is social, sensible, restrained by conventions, and repressed; ironically, it is Elinor, the social sister, who is forced into the exertion of concealment when Lucy Steele charges her with secrecy.  Marianne, however, prostrated by her inability to cope with disappointment, flaunts her grief.  Although she shuns society to grieve in isolation, she inadvertently inflicts her suffering on the people around her.  She listens to her heart instead of to her head; and she is “romantick” in the most fulsome sense of the word.

The Dashwood sisters never break out of the pattern the young author established for them in the first chapter when she outlined the broad contrasts between the two sister-heroines.  One sister exerts herself; the other suffers from indolence, languor, and lassitude.  Such a rigid pattern risks negating development, and the structural movement of the book is too static to appeal to many modern readers.  In fact, this novel generates more negative criticism than is accorded the juvenilia.  Some critics even claim that the dichotomy is between priggishness and silliness.

In Sense and Sensibility, however, Jane Austen is obviously probing the essence of correct behavior and right-mindedness.  In all of her novels, the invalids test the sense and sensibilities of the other characters by dividing loyalties or by demanding attentions at the most inopportune moments.  Perhaps the test situations are less subtle here, for the characters react to very serious manifestations of daily living – matters, that is, of life and death.  Illness, therefore, is this novel’s structural metaphor, and the characters’ responses to the plight of others define their morality.

The medical metaphor infuses the plot with a structural grace and thematic unity that is lacking in other eighteenth-century antithetical novels, such as Jane West’s A Gossip’s Story (1796), an important source study for Sense and Sensibility, but a rambling tale that relies heavily on digressions to make up for static action.  There are no digressions in Sense and Sensibility.  The characters’ physical and emotional complaints are linked to the theme of suffering and recovery.  Marianne’s twisted ankle and all her bouts of nervous headaches are integral to the resolution of the story.  Even when the Palmers’ baby “ ‘cried, and fretted, and was all over pimples,’ ”5 the plot moves forward, for when Mr. Donavan arrives from Harley-street his purpose in the plot is twofold: he quickly diagnoses the “red-gum” in the ailing child, and, more importantly perhaps, he carries word to Mrs. Jennings and the Dashwood sisters that Mrs. John Dashwood has fallen into fits upon discovering that Edward and Lucy have been engaged for a year.  Baby Palmer’s pimply condition in Chapter 1 of Volume III initiates the events that will lead to the conclusion.  Now that the secret has been broadcast, Elinor is released from her vow of silence; and, finally, it is time for Edward to exert himself, to defy not only his family but his own heart in order to fulfil his ill-conceived engagement promise to Lucy.

Structurally, Sense and Sensibility, perhaps more than Jane Austen’s other novels, reflects the vicissitudes of real life in the late eighteenth and early nineteenth centuries.



DIED: At Clea, Lincolnshire, Mrs. F. Bridlington, a maiden lady; she had lived in the most penurious manner; but after her decease, upwards of three thousand four hundred guineas (in gold) two pieces of 3£. 12s. some silver coin, and a great number of farthings, were found concealed in her house, curiously wrapped up in parcels, enclosed in small linen bags, and containing about 100£. each.  This treasure she is supposed to have been forty years in collecting.  – The weight of the whole was five stone two pounds.  She was also possessed of land to the amount of 5000£.  It is uncertain who is the heir at law.  (Le Beau Monde, March, 1808)


MARRIED: At Westbury Church, Mr. Thos. Field, aged 22, to Miss Patience Winterbottom, aged 67.  (Le Beau Monde, April, 1808)


MARRIED: The celebrated Scotch divorcee, the Countess of Elgin, to Mr. Ferguson, for an attachment to whom, she has, amongst other sacrifices, thus renounced her rank in the peerage.  (Le Beau Monde, June, 1808)


DIED: At Bath, William Siddons, Esq. the very worthy and affectionate husband of the justly celebrated Mrs. Siddons.  Though long an invalid, his dissolution may be said to have been sudden, as he had passed the preceding evening with a circle of friends in his usual social and pleasant manner.  (Le Beau Monde, April, 1808)


DIED: Lord Alexander Gordon, second son of the Duke of Gordon, at Edinburgh, in the 24th year of his age.  In consequence of his death, the Houses of Gordon, Bedford, Richmond, Manchester, and Cornwallis, go into mourning.  (Le Beau Monde, February, 1808)


DIED: At White Roding, in Essex, the Rev. Mr. William Cheere, Bart. at the advanced age of 78 years; the bulk of his fortune devolves to his two amiable nieces the daughters of his late and only brother.  The title becomes extinct.  (Le Beau Monde, April, 1808)



As in life, the action in Sense and Sensibility is shaped by financial, material, emotional, and moral responses to illness and death.  At the very beginning, the plot movement is initiated by the death of Mr. Dashwood and the consequent removal of his second family from Norland to Barton Cottage.  The reader is quickly informed about a number of demographic details about life and death in Jane Austen’s time.  First of all, Mr. Dashwood’s first wife (John’s mother) obviously died young, and the widower married again soon after her death, so that Elinor, the eldest daughter of the second family, is rather close in age to the son and heir.  Second, we learn from Mr. John Dashwood and his wife Fanny that Mrs. Dashwood, “who is very stout and healthy, and hardly forty” (10), could be expected to live as much as another fifteen years.  Therein lies the moral – well, financial – problem for the John Dashwoods: how to fulfill John’s promise to his dying father without being “completely taken in” by demographics that suggest a fifty-five-year life span.  They look at their problem from a perfectly selfish point of view and determine that “it would be absolutely unnecessary, if not highly indecorous, to do more for the widow and children of his father, than such kind of neighbourly acts as his own wife pointed out” (13).


MARRIED: At Harewood, Mr. John Benson, of East Keswick, aged 75, to Mrs. Fowler, of the same place, aged 85.  – The loving couple appeared in the highest spirits when going to pay their devoirs at the altar of Hymen.  She has 2000£. almost all in gold, hoarded together during the last century, and put under a large flag stone.  (Le Beau Monde, March, 1808)


MARRIED: At Otley, after a disconsolate widowhood of three months, Mr. Geo. Raistrick, of Hawkesworth, aged 78, to Mrs. Mitton, of Burleywoodhead, aged 60, making the fourth visit paid by the husband, and the third by his fair bride to the altar of Hymen.  In compliance with a vulgar notion, that the wife being married in a state of nudity, exonerates her husband from legal obligations to discharge any demands upon her purse, the lady, with much sang froid, began to disrobe herself at the altar, and did not desist till her chemise remained her only covering; thus having attained the very summit of the nude ton, the marriage ceremony commenced, and it was not until the whole had been deliberately gone through, that the parish sexton, in the capacity of waiting woman, began to dress this blooming daughter of Eve, and to revive, by the genial heat of warm clothing, that spark of hymeneal fire, which a chilling air and humid atmosphere had nearly extinguished.  (Le Beau Monde, June, 1808)


DIED: Lately, at Thurnham, in Kent, Mr. S. Jones.  He was remarkable for his penurious economy.  From the situation of a gentleman’s coachman, he rose to the possession of a fortune, and accumulated the sum of 27,000£. by denying himself the enjoyments of life.  He has bequeathed his property to a number of poor relations, to whom, during his life, he paid no attention.  – A niece, with a large family, to whom he left 2000£. died at Maidstone on the 11th ult.  (Le Beau Monde, June 1808)


This first act of betrayal fits into the pattern the author establishes early in the novel.  The characters’ responses to illness and death reveal their codes of behavior.  The John Dashwoods’ self-centered response to their father’s death and to the consequent hardships of their kin establishes their particular code, which will be contrasted to the moral and emotional responses of such characters as Elinor, Colonel Brandon, Mrs. Dashwood, and even Mrs. Jennings.  The John Dashwoods are so selfishly practical, so sensible of their own wants and needs, that they represent the very epitome of the lack of sensibility.

Interestingly, the same life span – 55 years – is suggested for Colonel Brandon as for Mrs. Dashwood: the Colonel is thirty-five, and “ ‘he may live twenty years longer’ ” (37).  Jane Austen is setting up another dichotomy – between youth and age, between infirmity and health.


DIED: He was a youth of much promise, and the only son of Earl Nelson.  – By his death, it is probable that the title, so gloriously acquired by the immortal Nelson, will go into the female line.  The two sisters, Mrs. Bolton and Mrs. Matcham, have each a numerous family; and failing issue male of the present lord, the next in remainder is Thomas Bolton, a minor.  (Le Beau Monde, February, 1808)


DIED: Lately, near Cullybackey, in Ireland, Martha Hanna, aged 126 years:  she was born near Dungannon, and remembered to have heard the shots fired in an engagement that took place there in the year 1690: she was a little woman, measured this last year four feet seven inches.  (Le Beau Monde, April, 1808)


When Marianne tells her mother in Volume I that she has “ ‘an alarm on the subject of illness,’ ” (38), her expression of concern resonates symbolically and realistically throughout the text.  Everyone in the novel – except Marianne – fears catching cold, but at Cleveland, of course, it is Marianne who, “in her plan of employment abroad, had not calculated for any change of weather during their stay ….  With great surprise therefore, did she find herself prevented by a settled rain from going out again after dinner ….  [A]n evening merely cold or damp would not have deterred her from it; but a heavy and settled rain even she could not fancy dry or pleasant weather for walking” (303).

It is not an exaggeration to say that all the characters in Sense and Sensibility focus their attention on the link between weather and illness, and in this concern art certainly imitates life.


[T]he animal constitution has seemed to acquire renovated vigour from the freshness of the breezes, and the opening beauties of spring.  Invalids, and persons of a delicate habit, especially those who have been subject to cough, catarrhal, and rheumatic complaints, should observe great caution in not suffering themselves to be allured by this young and gay season into long evening walks, or be induced by the noontide warmth to put on lighter raiment ….  (Ackermann’s, May, 1811)


Cold weather, and bleak winds, will occasion coughs in the soundest lungs, and cannot be too carefully avoided, where they are morbidly tender.  Warm covering, as a flannel waistcoat, will have its use ….  In the three or four summer months, the air in England is as mild as the tenderest lungs need breathe, and there can be no use in leaving this country from May until October …. (Heberden)


In delineating the characters’ focus on their own health and on the complaints of others, Jane Austen seems to be reflecting in her art some of the very real concerns of life at the beginning of the nineteenth century.  The Georgians were consumed by the thought that “wet shoes and stockings” (306) made the body susceptible to illness.  Marianne’s weakened constitution, coupled with her walking through the wet grass at twilight, leads rapidly to her coming down with


a cold so violent, as, though for a day or two trifled with or denied, would force itself by increasing ailments, on the concern of every body, and the notice of herself.  Prescriptions poured in from all quarters, and as usual, were all declined.  Though heavy and feverish, with a pain in her limbs, a cough, and a sore throat, a good night’s rest was to cure her entirely; and it was with difficulty that Elinor prevailed on her, when she went to bed, to try one or two of the simplest of the remedies.  (306)


In essence, the depiction of these physical problems in Sense and Sensibility reflects the layman’s interpretation of some of the medical ideas that were common knowledge at the turn of the nineteenth century.


A disagreeable tickling in the throat, causing a constant provocation to cough, is sometimes so importunate as to force the patient to have recourse to various means of procuring some present relief: a few raisins will sometimes answer this purpose ….  (Heberden)


The state of the weather not unfrequently arrests the arm of the intended suicide, or impels the fatal stroke ….  (Ackermann’s, January, 1809)


An important source for the study of illnesses and remedies during Jane Austen’s time is a monthly popular journal with the commodious title of Ackermann’s Repository of Arts, Literature, Commerce, Manufacturers, Fashions and Politics.  In each installment of the journal, the “Medical Report” addresses issues that were topical and timely.  In addition, the anonymous reporting physician provides a catalogue of medical problems, both chronic and acute, that his patients complained of during the previous month.


Chronic diseases.  – Pulmonary consumption, 2 …  Cough and Dyspnoea, 30 …  Cough and hemoptoe, 3 …  Scrofula, 2 …  Dyspepsia, 6 …  Dysentery, 2 …  Diarrhoea, 1 …  Chronic pains of the stomach and bowels, 12 …  Jaundice, 1 …  Dropsy, 4 …  Asthenia, 13 …  Head-ach and vertigo, 8 …  Spasm, 2 …  Lumbago and sciatica, 3 …  Hectica, 2 ...  Hypochondriasis, 2 …  Epilepsy, 1 ...  Palsy, 2 …  Worms, 3 …  Vomiting of blood, 2 …  Cutaneous diseases, 3 …  Morbi mulierum, 8.  (Ackermann’s, June, 1809)


We have scrutinized the medical reports in Ackermann’s during the years 1809-1811, the period just preceding the publication of Sense and Sensibility, in order to determine what illnesses were endemic or epidemic at the time and what remedies were brought to the public’s attention.  Ackermann’s Repository, which was read by a wide audience, gives us important clues about what doctors and ordinary people knew and believed about health and illness.


[It] is far from being the unanimous opinion of medical practitioners, that pulmonary consumption is infectious ….  I have no hesitation on the subject; it has been my painful lot to mark its progress in the young widow after the decease of her consumptive husband; frequently in sisters who have successively attended each other ….  (Ackermann’s, November, 1811)


Under the head cough and dyspnoea, to spare our readers the trouble of conning over barbarous and cacophonous terms, we class various disorders, of which cough and difficulty of breathing are merely symptoms, such as peripneumonia notha, or bastard peripneumony, a complaint extremely frequent in this country, very difficult to remove, and sometimes rendered fatal by bad treatment.  (Ackermann’s, December, 1810)


Ackermann’s even comments on how gout could drive a person to despair, and another fashionable magazine called Le Beau Monde obviously took great pleasure in reporting the following death:


DIED: On the 31st Jan. aged 54, Mr. John Lincoln, merchant of Beccles, whose death was occasioned by imprudently plunging his feet into cold water, during a paroxysm of the gout.  (Le Beau Monde, March, 1808)


At Barton Cottage, the medical metaphors proliferate.  Before Colonel Brandon even speaks in his own voice in the novel the reader is informed that he complains of “the rheumatism,” which Marianne interprets as “ ‘the commonest infirmity of declining life’ ” (37).  Marianne connects a flannel waistcoat “ ‘with aches, cramps, rheumatisms, and every species of ailment that can afflict the old and the feeble’ ” (38).  It is at this very early stage of the novel (Vol. I, Ch. 8) that Jane Austen cleverly introduces both the theme that will bind Marianne to Colonel Brandon and the setting that will dominate Volume III of Sense and Sensibility.  Elinor rebukes Marianne for “ ‘dooming Colonel Brandon and his wife to the constant confinement of a sick chamber, merely because he chanced to complain yesterday (a very cold damp day) of a slight rheumatic feel in one of his shoulders’ ” (38).  She teases Marianne about her penchant for the trappings of the romantic novel:  “ ‘Had he been only in a violent fever, you would not have despised him half so much.  Confess, Marianne, is there not something interesting to you in the flushed cheek, hollow eye, and quick pulse of a fever?’ ”  This seems to be a clear case of foreshadowing, for in Volume III Jane Austen inverts the situation she has set up in Volume I.  It is Marianne’s violent fever, flushed cheek, hollow eye, and quick pulse that bring both Willoughby and Colonel Brandon racing to her sick chamber.

To maintain unity and symmetry, Jane Austen sets up Marianne’s accident and her major illness so that they occur in early chapters in each of the three volumes.  More importantly, however, the author generates a pattern of medical situations moving from the external, and therefore least interesting, to the internal and finally to the life-threatening.  When Marianne sprains her ankle, and thereby meets Willoughby, in Volume I, chapter 9, she literally falls in love in her rush down the hill – and in the overall context of the novel, this headlong rush seems to be her last physical exertion, for contact with Willoughby weakens and debilitates Marianne, both emotionally and physically.  When, in Volume II, chapter 6, Marianne meets Willoughby again, and this time he shuns her, Marianne’s “nervous irritability” (180) and hysterics begin; by chapter 7, then, which is precisely at the core of this volume (Volume II has 14 chapters) Marianne has fallen ill, and her spirit fails as much as her body.  “[F]aint and giddy from a long want of proper rest and food” (185), she suffers from “an aching head, a weakened stomach, and a general nervous faintness.”

In the “Introduction” to the Penguin edition of Sense and Sensibility, Tony Tanner says that “Marianne’s illness is clearly psychosomatic and in many of its symptoms … her behaviour is pathological in a way which for the late eighteenth century could have been construed as madness.”6  Although Tanner goes on to say that Marianne “is indeed sick, sick with the intensity of her own secret passions and fantasies,”7 he seems to be diagnosing her according to twentieth-rather than early nineteenth-century standards.  Interestingly, many of Marianne’s symptoms would fit the descriptions of the puzzling popular illness of the 1980s known as Chronic Fatigue Syndrome (or Chronic Mononucleosis, Chronic Epstein-Barr Disease, or “Yuppie Flu”). Such unexplained illnesses are often thought of as psychosomatic today, but what we call psychosomatic disease was not a concept prior to Freud, or at least prior to the turn of the nineteenth century.  There is, though, a recognition – almost a preoccupation – with the physical effects of madness.  Critics who say that Marianne is exhibiting signs of madness might be interested in the fact that such symptoms as “head-aches, languor, occasional loss of memory, depression of mind, [and] aversion for amusement” were associated as well with “rheumatic complaints” and were thought to be treatable with “a few leeches, cupping blisters, &c.” to “reduce the morbid action in the brain” (Ackermann’s, August, 1810).  “[S]ome diseases appear to have been chiefly induced by the state of the atmosphere,” and “languor and debility” resulted from “the late continued unseasonable warmth of the weather” (Ackermann’s, November, 1811).

Medical theory in the late eighteenth century distinguished a number of debilitating conditions that have no one-on-one correspondence with entities identified by modern physicians.  VALETUDO CONQUASSATA, for example, was defined as:


A dangerous disease, or great decay of the parts necessary to life, occasions which is called a broken state of health; by which is meant an assemblage of many or most of the following complaints: A paleness, or sallowness of the countenance; a bloated face; thirst; shortness of breath; palpitation of the heart; flatulence; loathing of food; sickness; frequent making of water; incontinence of the stools and of the urine; swelling of the legs; wandering pains, spasms, wasting of the flesh; weakness; lassitude; itching of the skin; tremblings; numbnesses; feverishness; languor; faintings; sleepiness in the day-time; want of sleep at night; forgetfulness.  (Heberden)


It is clear that the Georgians would have believed that Marianne’s acute susceptibility to life-threatening illness was brought on by what Heberden lists as “Hysterical Affections” – that is, by Marianne’s focusing too much on her heartache – and by carelessly exposing herself to the elements.  Acute susceptibility to the weather, particularly in “nervous people and those subject to lowness of spirits,” is documented repeatedly by Ackermann’s medical reporter, especially “when the easterly winds have prevailed for a length of time” (Ackermann’s, January, 1809).

It seems appropriate to identify what is wrong with Marianne in the medical terms of the period and to assess what Jane Austen was trying to achieve in a book that is so structured by illness and accidents.  In two particularly revealing reports from Ackermann’s, the medical writer details some of the “diseases” that required extended definition for the general public.  In the November, 1809 “Medical Report,” the medical reporter defined hysteria:


The exciting cause of hysteria is not always apparent or to be ascertained.  It is frequently occasioned by emotions of the heart and passions of the mind, and may not occur till some time after the impression has been made; ….  This arises from the irresistible influence of sympathy, but may be only subdued by applying some stronger passion to the mind, as fear, shame, &c ….  The cause of females chiefly being attacked with hysterics, would appear to depend upon the delicacy of their organisation, the quickness of their perceptions, and their requisite sense of feeling, rather than on any sexual distinction …. and what would be derided in a man, because he is strong and capable of self-defence, renders a woman amiable ….  (Ackermann’s, November, 1809)


Perhaps more relevantly, a chronic condition called “asthenia” was reported to the general public regularly in the Medical Report of Ackermann’s Repository.  In December, 1810 the following commentary was given:


Under the head asthenia, we rank besides those of simply general debility, various nervous affections, to which it would be difficult to assign any suitable name ….  Whether it is from the refinement, the luxury, or the indolence of modern manners, the distraction of public affairs, or the ruined fortune and baffled hopes of private speculators, certain it is, that the present generation is visited with a train of evils unknown to our more hardy progenitors.  Nervous symptoms increase amongst us in an alarming degree; and in their train, stalks with hasty and giant strides, that mental malady, whose approach is more terrific than that of death.  If the delicate and sensible frame of females be less exposed to the rude touch of these calamities, it is assailed by a more insidious, but not less destructive foe.  The romance which nightly steals from slumber, and harrows up the soul with the ideal vision of departed spirits; the tale of murder inscribed in characters of blood; the burning fever of love; the hopes, the fears, the raptures, the despair of some forlorn youth, or cupid-stricken maid; all exert a powerful influence on the susceptible and finely-wrought female mind, induce a morbid sensibility, an enfeebled, enervated frame, and a disjointed association of ideas.  – An eminent author has observed, “The mind that can amuse itself with the trash of most modern novels, seeks an enjoyment beneath the level of a rational being.  It creates for itself an ideal world, on the loose descriptions of romantic love, that leaves passion without any moral guide in the real occurrences of human life.  To the female mind, in particular, as being endued with finer feelings, this species of literary poison has often been fatal.”  (Ackermann’s, December, 1810)


Whether she suffers initially from hysteria or asthenia, Marianne becomes physically ill at Cleveland, and she almost dies of the “bad cold” she so carelessly courted.  The Palmers’ apothecary pronounces “her disorder to have a putrid tendency” and he even allows “the word ‘infection’ to pass his lips” (307), but there is little evidence in the text that Marianne had the typical clinical course or characteristic rash of typhus or “putrid fever.”  “Infection” thus becomes a mechanism of the plot, a ploy to get the Palmers to remove immediately from their home.

In Volume III, chapter 7, there is perfect fusion of symbolism and realism.  The author has developed her story symmetrically: Marianne’s hysteria and asthenia began in chapter 7 of Volume II, and her life-threatening illness is at its worst in chapter 7, in the “heart” of Volume III, which, like Volume II, also has 14 chapters.  In Volume III, just when Willoughby appears at Cleveland in the dead of night because he has heard that Marianne is dying of a putrid fever, Marianne begins to recover both physically and spiritually.  Even as Willoughby confesses himself to be a cad of the worst order, Marianne’s fever – not her heart – finally breaks.

Surprisingly, the remedies suggested for Marianne’s various complaints are innocuous and only briefly described.  There is no real blood-letting in Sense and Sensibility, and (if we don’t count Willoughby) there are no leeches at all, even though contemporary medical practice thoroughly condoned the use of leeches for a variety of illnesses.  Like the corner apothecary, Mrs. Jennings always has a remedy or two to prescribe – constantia wine for gout, “salts” for nervous distress, and “hartshorn” for fainting, for example, but poor Mrs. Jennings often gets the diagnosis wrong in the first place, so it is a blessing that her nostrums are ignored by the person who is ill.


It is true, that although they have worn an anodyne necklace, or a magic belt, swallowed a succession of drops, and even largely used specific embrocations, some infants have the good fortune to escape alive.  But these either have not had the complaint at all, or they have had it very slightly ….  (Ackermann’s, December, 1809)


… it were absurd to suppose that the same remedy should cure, or prove beneficial, in dissimilar and opposite circumstances: yet this impossibility is expected to be accomplished by quack medicines!  (Ackermann’s December, 1809)


In her letters, however, Jane Austen mentions many remedies.  She tells Cassandra on 23 June 1814 that “we [at Chawton] had handsome presents from the Gt. House yesterday – a ham and the four leeches” (#97).  Another time she reports that their “mother has not been down at all today; the laudanum made her sleep a good deal, and upon the whole I think she is better” (#10; Saturday 27 October 1798).  In other letters, she asks Cassandra to “purchase for [Martha] two bottles of Steele’s Lavender Water when you are in Town” (#31; Wednesday 14 January 1801), or she writes that “Mercury” has been used in the treatment of “little Harriet’s head-aches” (#142; Sunday 23 March 1817).

In her letters, just as in her novels, Jane Austen treats ailments and accidents as a fact of life.  The illnesses and accidents of neighbors provide Jane Austen with an unlimited source for satiric commentary.  In one very famous bit of malicious gossip intended for her sister, the twenty-three-year-old Jane comments on how “Mrs. Hall, of Sherborne, was brought to bed yesterday of a dead child, some weeks before she expected, owing to a fright.  I suppose she happened unawares to look at her husband”  (#10; Saturday 27 October 1798).  Lady Bridges’ health was a great topic in Jane’s letters to Cassandra in 1813, and she knew specific details of her treatment.  The apothecary, she reported, “took twelve ounces of Blood from her when the Gout appeared, & forbids wine &c.” (#91; Saturday 6 November 1813).

Relatives endured the usual illnesses and accidents of the time.  Wives died in childbirth; Thomas Fowle, Cassandra’s fiance, died from yellow fever; Mrs. LeFroy died from being thrown by a horse.  The Austen family also suffered from one of the more unusual “accidents” of the late eighteenth century: the husband of their cousin Elizabeth de Feuillide was guillotined in France in 1794.  Jane Austen’s novels, therefore, with all the orphans and widows and widowers who populate the towns, give a perfect world picture of her times, and her letters (like her novels) chronicle both humorously and seriously the very human ailments that beset her family and friends.


DIED: Lately, at Bucknall, Staffordshire, Mr. T. Ash, aged 92, who has left to deplore his loss 11 children, whose ages amount to 664 years – 47 grand children, ages amounting to 1330 years – 48 great grand children, ages amounting to 433 years – and 1 great great grand child, exclusive of a grand son by marriage, aged 76.  (Le Beau Monde, March, 1808)


The Austens themselves seemed to be rather hardy and vigorous, with Mr. Austen dying at the age of 74 and Mrs. Austen at 88.  Of the Austens’ eight children, all survived Jane, who was the seventh of the eight.  Jane herself had remarkably good health most of her life, although she and Cassandra, like Marianne Dashwood, almost died of “putrid fever” in 1783.  Jane Austen comments quite often on her brothers’ health, noting in detail that “Henry’s illness is much more serious than I expected ….  There is a little pain in the chest, but it is not considered of any consequence.  Mr H[aydon, the apothecary from Sloan Street] calls it a general inflammation.  He took twenty ounces of blood from Henry last night, & nearly as much more this morning, & expects to have to bleed him again to-morrow – but he assures me that he found him quite as much better to-day as he expected.  Henry is an excellent patient, lies quietly in bed & is ready to swallow anything.  He lives upon medicine, tea & barley-water.  He has had a great deal of fever but not much pain of any sort, & sleeps well” (#111; Tuesday 17 October 1815).  Five weeks later, she wrote again of Henry’s health: “The fever is not yet quite removed.  – The Medicine he takes (the same as before you went) is chiefly to improve his Stomach, & only a little aperient.  He is so well, that I cannot think why he is not perfectly well.  – I should not have supposed his Stomach at all disordered but there the Fever speaks probably; – but he has no headake, no sickness, no pains, no Indigestions!” (#117; Sunday 26 November 1815).

Jane Austen occasionally focuses on her mother’s state of health.  After taking to her bed complaining of a siege of fever and pains in her side, “My mother,” Jane writes,


made her entree into the dressing-room through crowds of admiring spectators yesterday after-noon, and we all drank tea together for the first time these five weeks.  She has had a tolerable night, and bids fair for a continuance in she same brilliant course of action to-day ….  Mr. Lyford was here yesterday; … he wants my mother to look yellow and to throw out a rash, but she will do neither  (#13; Saturday 1 December 1798).


On her father’s death on 21 January 1804 Jane Austen wrote to her brother Francis:


Our dear Father has closed his virtuous & happy life, in a death almost as free from suffering as heretofore, an oppression in the head, with fever, violent tremulousness, & the greatest degree of Feebleness.  The same remedy of Cupping, which had before been so successful, was immediately applied to – but without such happy effects.  The attack was more violent, & at first he seemed scarcely at all releived by the operation.  – Towards the Evening however he got better, had a tolerable night ….  But as the day advanced, ... the fever grew stronger than ever, & when Bowen saw him at ten at night, he pronounc’d his situation so be most alarming.  – At nine this morning he came again – & by his desire a Physician was called in; – Dr. Gibbs – But it was then absolutely a lost case –.  Dr. Gibbs said that nothing but a Miracle could save him, and about twenty minutes after Ten he drew his last gasp.”  (#40)


Yet she could also write satirically of death: “Only think of Mrs. Holder’s being dead!  – Poor woman, she has done the only thing in the World she could possibly do, to make one cease to abuse her” (#87).


Of her own health, Jane Austen writes less frequently: “I feel rather languid and solitary – perhaps because I have a cold …  (#51; Wednesday 15 June 1808).  When Mr. Lyford dropped in for a visit once, she noted ironically “that he was disappointed of his son & daughter’s coming, & must go home himself the following morng; – & as I was determined that he shd not lose every pleasure I consulted him on my complaint.  He recommended cotton moistened with oil of sweet almonds, & it has done me good” (#55;

Saturday 1 October 1808).  In 1816, she writes that “Composition seems to me Impossible, with a head full of Joints of Mutton & doses of rhubarb” (#133; Sunday 8 September 1816); her tone here may be ironic and self-deprecating, but in March 1817 she wrote to Fanny Knight that her letter is “languid  dull & very bad company” (# 142; Sunday 23 March 1817).  On 22 May, 1817, Jane Austen wrote to Anne Sharp:


Your kind Letter my dearest Anne found me in bed, for in spite of my hopes & promises when I wrote to you I have since been very ill indeed.  An attack of my sad complaint seized me within a few days afterwards – the most severe I ever had – & coming upon me after weeks of indisposition, it reduced me very low.  I have kept my bed since 13. of April, with only removals to a Sopha.   Now, I am getting well again, & indeed have been gradually tho’ slowly recovering my strength for the last three weeks.  I can sit up in my bed & employ myself, as I am proving to you at this present moment, & really am equal to being out of bed, but that the posture is thought good for me. – …  I have so many alleviations & comforts to bless the Almighty for!  – My head was always clear, & I had scarcely any pain; my cheif sufferings were from feverish nights, weakness and Languor.  – This Discharge was on me for above a week, & as our Alton Apothy did not pretend to be able to cope with it, better advice was called in.  Our nearest very good, is at Winchester, where there is a Hospital & capital Surgeons, & one of them attended me, & his applications gradually removed the Evil.  – The consequence is, that instead of going to Town to put myself into the hands of some Physician as I shd otherwise have done, I am going to Winchester instead, for some weeks to see what Mr Lyford can do farther towards re-establishing me in tolerable health ….  I am now really a very genteel, portable sort of an Invalid  (#145).


Some days later, she retreats when she feels she is “getting too near complaint.  It has been the appointment of God,” she deems (#147; To ––––– end of May? 1817).


Jane Austen died at approximately 4:30 a.m. on 18 July 1817.  Sir Zachary Cope has postulated that her fatal illness was Addison’s Disease,8 now known to be due to tuberculosis of the adrenal glands, and entirely curable with rather simple drug therapy.  This treatment, however, was not available for another 130 years.





1  For this paper, we have quoted at length from two primary sources: the “Medical Report” in The Repository of Arts, Literature, Commerce, Manufacturers, Fashions and Politics, published for R. Ackermann, London; and Le Beau Monde, or Literary and Fashionable Magazine, printed by and for J.B. Bell and Co., London.  All quotations from these sources will be identified by dates in in-text citations.


2  R.W. Chapman, ed., Jane Austen’s Letters to her Sister Cassandra and Others (Oxford: Oxford University Press, 1932), p. 93.  All further quotations from Jane Austen’s letters will be taken from this edition.


3  A.F. Fremantle, England in the Nineteenth Century 1806-1810 (London: George Allen & Unwin Ltd., 1930), p. 89.


4  London: 1798; reprinted Boston: Wells and Lilly, 1818.  All quotations from Heberden will be taken from this edition.


5  Jane Austen, Sense and Sensibility, Vol. I of The Novels of Jane Austen, ed. R.W. Chapman, 3rd ed. (London: Oxford University Press, 1933), p. 257.  All further quotations from Sense and Sensibility are taken from this edition.


6  Tony Tanner, “Introduction” to Jane Austen’s Sense and Sensibility (New York: Penguin Books, 1982), p. 13.


7  Tanner, p. 15.


8  British Medical Journal, 2, 1964, pp. 182-83.  Debate about the cause of Jane Austen’s death continues; further discussion would be the topic of another paper.

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